What helps against menopause symptoms like hot flushes and mood swings?

Hormone therapy with oestrogen works best against hot flushes and night sweats. Several international guidelines confirm this. It works optimally if you are within ten years of your last period and have no contraindications, such as oestrogen-dependent tumours or certain cardiovascular problems.

Would you prefer not to use hormones, or are they not suitable for you? There are three non-hormonal medications with strong clinical evidence. Antidepressants such as paroxetine and venlafaxine demonstrably reduce hot flushes, but can cause nausea and reduced libido. Gabapentin also works, but causes dizziness in some people. Fezolinetant is newer and acts specifically on the brain mechanism behind hot flushes. It also appears to help with sleep and mood complaints, but there is still little long-term data. Oxybutynin, known as a medication for bladder cramps, also carries a recommendation, although the evidence is somewhat less strong.

Prefer no medication at all? Cognitive behavioural therapy and clinical hypnosis are the best-supported options for hot flushes, anxiety and sleep problems. With cognitive behavioural therapy, you learn to cope with your symptoms differently. Clinical hypnosis requires a specialist therapist, but performs well in solid research. Both are fully valid alternatives.

Diet and lifestyle help only to a limited extent. Omega-3 fatty acids and vitamin D have a modest positive effect on mood and anxiety, but the effects are small and the variation between studies is large. Weight loss helps with hot flushes and is also good for your heart and blood vessels. Exercise and strength training improve your physical and mental wellbeing, but have not been convincingly proven to reduce hot flushes themselves.

The 2023 NAMS guideline explicitly advises against herbal remedies and soy supplements: good to reasonable research shows insufficient effect. Yoga, mindfulness and acupuncture are likewise unproven for hot flushes. For controlled breathing, there is even strong evidence that it does not work. These techniques may improve your general wellbeing, but they do not resolve hot flushes.